Usefulness of peroral direct cholangioscopy for confirmation and removal of residual bile duct stones

Abstract

AIM : We evaluated the treatment outcome of peroral direct cholangioscopy (PDCS) for confirmation and removal of residual bile duct stones after a negative endoscopic retrograde balloon-occluded cholangiography. METHOD : PDCS was attempted for 14 patients in order to confirm the presence of residual stones. 10 patients had normal stomachs, one had Billoth-II (B-II) reconstruction, two had Roux-en-Y (R-Y) reconstruction, and one had pancreatoduodenectomy (PD) . RESULTS : The endoscope could be advanced to the bile duct in 10 patients (71%) , with the patients of normal stomach being the lowest at 60%. In patients with altered gastrointestinal anatomy, insertion of a scope was possible in all patients. The residual stones were observed in 5 patients. The residual stones were successfully extracted directly under PDCS in 4 of these patients (80%) . Early complications occurred in 14% (pancreatitis1, cholangitis1) ; both have improved by conservative treatment. CONCLUSION : PDCS is a useful endoscopic procedure for the evaluation and extraction of residual bile ducts stones, especially in the patients with altered gastrointestinal anatomy.